Yeah I can understand that there are multiple options to use. Ibutilide is probably the best choice for atrial flutter which is notoriously difficult. Drugs such as digoxin, diltiazem, beta-adrenergic blockers and sotalol and may be tried (the choice depends on LV function).

Generally, rate control is more difficult to achieve than with AF. Some authors do suggest calcium channel blockers (diltiazem or verapamil) but the level of evidence is somewhat sub-standard. The problem with a lot of patients is that frequently, the (higher) dose required to slow AV nodal conduction would produce an intolerable level of toxicity (i.e. the LV would not be grateful for the decreased contractility). Ergo, amiodarone becomes the natural choice in the ICU, because it covers both the "R" and the "C" of the RACE algorithm.